In November, the state Department of Managed Health Care found Blue Shield violated state law by misleading consumers about the size of its provider networks, a finding Blue Shield disputed.

In Santa Cruz County, Blue Shield is offered by large public sector employers: UC Santa Cruz, Cabrillo College, county government, the City of Santa Cruz, Santa Cruz City Schools, San Lorenzo Valley Unified School District and the Pajaro Valley school district.

Employees tend to pick health plans with doctors at PAMF, which has been expanding facilities, such as the new three-story office on the Santa Cruz Westside.

County supervisor Zack Friend and his wife, assistant Santa Cruz city manager Tina Shull, are first-time parents of a newborn delivered at Sutter Maternity & Surgery Center, which has a patient experience score of 88 percent compared to the state average of 68 percent.

Friend and Shull have to either pay PAMF’s higher rates to see the PAMF pediatrician they chose or switch doctors.

The same goes for new county supervisor Ryan Coonerty and his wife Emily, who chose Sutter Maternity for delivery of their newborn.

Blue Shield warned plan members they would face higher out-of-pocket costs from Sutter and PAMF. The member’s cost-share percentage is the “in network” level but since the contract was terminated, Sutter’s charges are higher.

City of Santa Cruz spokesman Keith Sterling estimated 50 percent to 75 percent of the city’s 339 employees with Blue Shield have a PAMF doctor.

“We are working with CalPERS to see if they will allow our employees to switch to a different plan that accepts PAMF,” he said, noting coverage runs through March 31. “If an agreement is not reached, they will be assigned a new provider in the Physicians Medical Group.”

Physicians Medical Group has more than 300 providers; PAMF had 175 full-time providers last year.

Local residents will have fewer options as Harbor Medical Group, a Santa Cruz obstetrics practice with four doctors, will close Jan. 30 due to state cuts in reimbursements for seeing MediCal patients.

Two doctors are retiring. One will join Dignity Dominican Medical Group, another will commute to El Camino Hospital in Mountain View and 20 employees will be out of work. —— (c)2015 the Santa Cruz Sentinel (Scotts Valley, Calif.) Visit the Santa Cruz Sentinel (Scotts Valley, Calif.) at www.santacruzsentinel.com Distributed by Tribune Content Agency, LLC AMX-2015-01-21T05:16:00-05:00

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